Test Review Flashcards
Tonsillectomy
-Contraindications
- Active infection (can spread the infection)
2. Cleft palate
Tonsillectomy
-Signs of Post Op Bleeding? ***TEST
Monitor For:
- Excessive swallowing
- Elevated pulse; decreased blood pressure
- Signs of fresh bleeding in the back of the throat
- Vomiting bright red blood
- Restlessness not associated with pain
Tonsillectomy
-Pre-Op considerations
- Assess for allergies, difficulty breathing or airway obstructions
- Assess for active infection
- Assess for loose teeth
Tonsillectomy
-How to Assess Bleeding Post Op
- Use flashlight to assess bleeding
- DO NOT use a tongue depressor
- ONLY USE STERILE EQUIPMENT
Tonsillectomy
-Post-Op Care
- Vomiting coffee grounds is common
- Don’t use red colored drink and meds that can be confused w/ blood
- Avoid citrus and carbonated drinks for 10 days
- Monitor bleeding and infection
Croup
-Caused by?
- Parainfulenza virus
Croup
-Signs & Symptoms
- Inspiratory stridor
- Harsh, bassy, barky, croupy cough
- Hoarseness
- Respiratory distress
- Fever (up to 104 F)
Croup
-Onset and Manifestations
- Often begins at night
- May be preceded by several days of symptoms of upper respiratory tract infection - Use of accessory muscles to breathe
- Frightened appearance
- Agitation
- Cyanosis
Croup
-Management
- Maintain airway
- Increased fluids
- Cool night air may relieve mucosal swelling
- Crying aggravates
- Dexamethasone
Bronchiolitis
- Inflammation of the bronchioles
- Respiratory synctial virus (RSV) is the causative agent in 50% of cases of bronchiolitis TEST
- Significant cause of hospitalization in children under 1 year of age
Bronchiolitis
-Pathophysiology
- Obstruction of bronchioles
- Infants small bronchioles obstruct easily
- Airway resistance on inspiration and expiratoin
Bronchiolitis
-Leads to?
- Gas exchange impaired
- Metabolic acidosis
- Ill during first 48-72 hrs
- Symptoms 10-14 days
Respiratory Synctial Virus (RSV)
-Statistics
- Infants usually acquire from older child or adult
- Highly communicable
- Nosocomial outbreaks in Ped’s hospitals are common
Respiratory Synctial Virus (RSV)
-How it is Transmitted?
- Contact w/ contaminated surfaces and hand to hand transmission
- Can live on skin and paper for 1 hour and cribs for 6 hours
- Contact isolation and scrupulous hand hygiene
Respiratory Synctial Virus (RSV)
-When Does it Happen?
- Annual epidemics
- Winter and early spring
- Immunity does not occur
- incidence decreases w/ age - Nearly 100% of children have RSV by age 2
Bronchiolitis/RSV
-How it Starts?
- It is usually preceded by mild upper respiratory infection
- Nasal drainage, sneezing, low-grade fever, and anorexia for several days
Bronchiolitis/RSV
-Acute Respiratory Distress Phase
- Follows upper respiratory infection
- S/S of this phase are:
- Tachypnea (60-80 breaths per min)
- Tacycardia (>140)
- wheezing, crackles, or rhonchi
- Retractions
- Cyanosis
- Either hypothermic or fever up to 105 F
Bronchiolitis/RSV
-Treatment if Hospitalized
- Cool humidified O2 with O2 sat <90%
- IV if dehydrated from tachypnea
- Head and chest at 30-40 degrees to open airway
- No antibiotics unless secondary bacterial
Bronchiolitis/RSV
-Reason for Cool, Humidified O2 for Treatment?
- Cool, humidified O2 is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea
Bronchiolitis/RSV
-What Does Nasal Flaring Indicate?
- Nasal flaring is a sign of respiratory distress
- Infants have trouble breathing through mouth
- Nasal flaring is usually accompanied by extra respiratory efforts.
- Allows more air to enter as the nares flare
Bronchiolitis/RSV
-Signs of Dehydration
- Decreased Urine
- Sunken fontanels
- Weight loss
- Dry membranes
- Skin turgor
Asthma
-Definition
- A reversible obstructive airway disease characterized by
- Airway responsiveness to a variety of stimuli
- Bronchospasm resulting from constriction of bronchial smooth muscle
- Inflammation and edema of mucous membranes that line small airways and subsequent accumulation of thick secretions in airways
Asthma
-Statistics
- Leading cause of acute and chronic illness in children
- Most frequent admitting diagnosis
- Incidence and death is increasing
- Prevalence of asthma is children is 9.6%
- affects 7.1 million children
Asthma
-Causes?
- Genetic and environmental factors
- Inflammatory alteration
- Underlying allergy
- More prevalent in urban areas where children are exposed to triggers
Asthma
-Immediate Reaction (Early Phase Response)
- Allergens activate IgE
- Release of histamine, leukotrienes, prostaglandins
- Cause Broncho-constriction quickly
- Resolves 1-2 hrs
Asthma
-Delayed Reaction Late Phase
- Chemical mediators attract immune system cells to respiratory tract
- Inflammatory substances damage epithelial and smooth muscle cells
- Edema, mucous plugging of small airways
- Broncho-constriction for several hrs
- Can last for weeks
Asthma
-Manifestations
- Increased airway resistance and respiratory distress from mucous and narrow airways
- Difficulty EXHALING
- Wheezing heard on exhale
- Air becomes trapped –HYPERINFLATION OF ALVEOLI
Asthma
-Manifestations cont..
- Wheezing during expiratory phase is classic sign
- Dry cough
- SOB and non productive cough
- Dyspnea on exertion
- Retractions & nasal flaring
- Tachypnea
Asthma
-Triggers
- Exercise (one of the most common)
- Cold Air
- Cigarette smoke
- Cockroach droppings
- Viral infection
- Stress
Asthma
-In Infants and Young Children
- The airway in infants and young children is narrower, and respiratory distress can occur quickly
Asthma
-Symptoms Indicating Emergency
- Worsening wheeze, cough, SOB
- Difficulty breathing
- No improvement after bronchodilator use
- Trouble with walking or talking
- Listlessness, weak cry in infant; refusal to suck
- Grey or blue lips or fingernails
Asthma
-Peak Flow Meter
- Explain to the parents that a peak flow meter is a device used to monitor breathing capacity in the child w/ asthma
Otitis Media
-Definition
- Effusion and infection or blockage of the middle ear
Acute Otitis Media (AOM)
- Effusion in the middle ear that occurs suddenly and is associated with other sings of illness
Otitis Media with Effusion (OME)
-Definition
- The presence of fluid behind the tympanic membrane WITHOUT SIGNS OF INFECTION
- Often follows an episode of AOM and usually resolves in 1-3 months
Acute Otitis Media
-Manifestations
- Earache (otalgia); infants may pull their ears or roll their heads
- Bulging, opaque tympanic membrane that looks red, w/ decreased mobility; diffuse light reflex; and obscured landmarks
- Drainage, usually yellowish green, purulent, FOUL SMELLING (indicates perforation of the tympanic membrane
Acute Otitis Media
-Indication of Foul Smell?
- Yellowish green, purulent, and foul smelling indicates PERFORATION OF THE TYMPANIC MEMBRANE
Otitis Media with Effusion
-Manifestations
- Tinnitus, popping sounds
- Hearing loss (usually conductive) below 35 decibels
- Mild balance disturbances
Otitis Media Management
- Pain relief
- Antibiotics
- Reduce Risk Factors
Roseola
- Human Herpesvirus 6 (HHV-6)
- Incubation: possibly 9-10 days
- Infectious period is unknown
- Transmitted through: Contact w/ secretions
- Saliva, CSF
Roseola
-Manifestations
- Usually 6-18 months
- Sudden high fever (103-106 F)
- Rash appears after fever subsides
- Pink maculopapules that blanch with pressure ***TEST
- Cough, runny nose, abdominal pain, headache, V/D
Rubella (German Measles: 3 day measles)
- Virus
- Incubation: 14-21 days
- Infectious period: 7-14 days after rash appears
- Transmission: Airborne particles, direct contact w/ droplets, placenta
- Immunity: Natural disease, Vaccine
Rubella (German Measles: 3 day measles)
-Incubation time?
- 14-21 days
Rubella (German Measles: 3 day measles)
-Infectious Period
- 7 days prior to 14 days after rash appears
Rubella (German Measles: 3 day measles)
-Transmission
- Airborne particles
- Direct contact w/ droplets
- Placenta
Rubella (German Measles: 3 day measles)
-Immunity
- Natural disease
2. Vaccine
Rubella (German Measles: 3 day measles)
-Rash and Manifestations
- Rash at 14-16 days
- Asymptomatic till rash appears
- Rash is pink maculopapular
- Rash begins on face, scalp and neck
- Petechiae on soft palate
Rubella (German Measles: 3 day measles)
-S/S
- Nasal Drainage
- Diarrhea & Nausea
- Sore throat & malaise
- Low grade fever, aches, & chills
Maternal Rubella
- During 1st 12 weeks of pregnancy (1st Trimester)
- Intrauterine Growth Retardation IUGR
- Failure to thrive
- Pneumonia, heart defects, encephalitis and immune deficiency
Rubella (German Measles: 3 day measles)
-Treatment
- Treatment is supportive
2. Keep away from other children until 7 days after rash begins
Rubeola (Measles)
- Virus
- Incubation: 8-12 days from exposure
- Infectious: 3-5 days before rash appears to 4 days after
- Transmission: Direct contact with droplets: Can be airborne
- Immunity: Natural or live attenuated vaccine
Rubeola (Measles)
-Incubation
- 8-12 days from exposure
Rubeola (Measles)
-Infectious period?
- 3-5 days before rash appears to 4 days after
Rubeola (Measles)
-Transmission
- Direct contact with droplets
- Can be airborne
Rubeola (Measles)
-Immunity
- Natural or live attenuated vaccine
Rubeola (Measles)
-Characteristics
- Spreads slowly
- Fever, runny nose, cough, conjunctivitis
- Quite ill
- photophobia
- Koplik spots 2-4 days prior to rash
Rubeola (Measles)
-What to Look for during Assessment?
- Koplik spots are found 2-4 days prior to rash
Rubeola (Measles)
-Disease Process
- Begins on face
- Spreads to trunk and extremities
- Red rash blanches easily
- Gradually turns brownish
Rubeola (Measles)
-Statistics
- 10 million cases each year
2. 197,000 die each year
Rubeola (Measles)
-Treatment
- Restrict activity - quiet bed rest
- Acetaminophhen or ibuprofen for fever
- Increased fluid intake
- Lukewarm baths
- Lubriderm & antihistamines
- Mittens if child scratches
Rubeola (Measles)
-Precautions
- Airborne precautions
- Vitamin A supplements
- MMR vaccine 2 doses
- 1st dose - 1 year
- 2nd dose - 4-6 years - MMR vaccine may be given sooner but, at least 4 weeks from last dose)
MMR Vaccine
- 1st dose - 1 year
- 2nd dose - 4-6 years
- May be given sooner but, at least 4 weeks from last dose
Pertussis (Whooping Cough)
-Vaccine
- AAP in 2005 recommended a booster, called:
- Tdap
- recommended for children age 11 to 12 who completed a primary series of DTap - This replaces the first of the recommended 10-year Td boosters
Fifth’s Disease
- Parovirus B-19
- Incubation: 4-14 days (up to 21 days)
- Infectious: between 5-12 days of infection
- Transmission: airborne particles, respiratory droplets, placenta
- Immunity: Natural disease
Fifth’s Disease
-Incubation
- Caused by parovirus B-19
2. 4-14 days (up to 21 days)
Fifth’s Disease
-Duration a person is Infectious
- Between days 5-12 of infection
Fifth’s Disease
-Transmission
- Airborne particles
- Respiratory droplets
- Placenta
Fifth’s Disease
-Immunity
- Natural Disease
Fifth’s Disease
-Manifestations
- Red cheeks
- Rash that comes and goes
- May be asymptomatic
- Rash may last 2-39 days
- Headache, runny nose, fever
Fifth’s Disease
-Rash Characteristics
- Rash on trunk and extremities after face
Fifth’s Disease
-Aggravating factors
- Heat
- Exercise
- Warm Bath
Fifth’s Disease
-Protecting Pregnant Women?
- Identify pregnant family members and teachers
- Intrauterine infection causes FETAL DEATH
- 15% increased risk of miscarriage if infected during 1st 20 weeks
Chickenpox
-Nursing Interventions
- Antihistamines for itching
- Acetaminophen for fever
- Acyclovir for severe cases
- works well if started early in window - PRIVATE ROOM W/ STRICT ISOLATION
- Bag contaminated materials and label
- Nurse should not be assigned to immunocompromised pt at the same time
Sudden Infant Death Syndrome (SIDS)
-Definition
- Deaths in infants less than 1 year of age that occur suddenly and unexpectedly, and whose cause of death are not immediately obvious prior to investigation
Sudden Infant Death Syndrome (SIDS)
-Statistics
- Occurs most frequently in the 2-4th month
- 95% before age 6 months
- More common in boys and low birth weight
- Lower socioeconomic
- Winter
- American Indians followed by African Americans
Sudden Infant Death Syndrome (SIDS)
-Intrinsic (Non-modifiable Risk Factors)
- Genetic
- Male
- Prematurity
- Prenatal exposure to cigarettes or alcohol
Sudden Infant Death Syndrome (SIDS)
-Extrinsic (Modifiable) Risk Factors
- Prone sleeping
- Bed sharing
- Use of soft bedclothes or mattresses
- Putting infant to sleep on upholstered furniture or adult mattress
- Exposure to cigarette smoke
Sudden Infant Death Syndrome (SIDS)
-Ways to Prevent SIDS
- Breastfeed as much and for as long as you can
- Schedule and go to all well-child visits
- Keep baby away from smokers and places where people smoke
- Do not let your baby get too hot
- Offer a pacifier at nap time and bed time
Sudden Infant Death Syndrome (SIDS)
-Common autopsy findings
- Pulmonary edema (fluid)
- Vascular congestion
- Pulmonary inflammation
- Retarded postnatal growth
Leukemia
- Most common childhood cancer
- Group of malignancies that affect the bone marrow and lymphatic system
- Classified by type of WBC’s that become neoplastic
Leukemia
-2 Groups
- ALL
- Acute lymphoid leukemia - AML/ANLL
- Acute myelogenous or non-lymphoid leukemia
Acute Lymphocytic Leukemia (ALL)
-Characteristics
- A fast-growing cancer in which the body produces a large number of immature WBC’s (lymphocytes)
Acute Lymphocytic Leukemia (ALL)
-Statistics
- ALL makes up 80% of childhood acute leukemias
- Most cases occur in children ages 3-7
- The disease may also occur in adults
Acute Lymphocytic Leukemia (ALL)
-Patho
- In acute leukemia, cancerous cells multiply quickly and replace normal cells
- Cancerous cells take over normal parts of the bone marrow, often causing low blood counts
Acute Lymphocytic Leukemia (ALL)
-Risk Factors
- Most cases of ALL have no obvious cause
- The following may play a role in development of leukemia:
- Chromosome problems
- Radiation exposure & past chemo
- Bone marrow transplant
- Toxins such as benzene // Down syndrome and other genetic disorders
Acute Lymphocytic Leukemia (ALL)
-Symptoms of ALL
- A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells and platelets
- Shortage of RBC’s and normal WBC’s
Acute Lymphocytic Leukemia (ALL)
-Shortage of RBC’s results in?
- Shortage of RBC’s causes symptoms of anemia including:
- Fatigue or weakness
- Dizziness
- Feeling cold
- Light-headedness and SOB
Acute Lymphocytic Leukemia (ALL)
-Shortage of Normal WBC’s causes?
- Fever
2. Recurring infections
Acute Lymphocytic Leukemia (ALL)
-Treatment Statistics
- Majority of children go into remission and remain symptom free when treatment is completed
- Children dx with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%
